- Humana (Annapolis, MD)
- …level by driving real impact and shaping the future of claims management? As a Senior Pharmacy Claims Professional , you will play a pivotal role in ... and take the lead on building solutions that make a difference! The Senior Pharmacy Claims Professional analyzes and answers inquiries regarding… more
- Humana (Annapolis, MD)
- **Become a part of our caring community and help us put health first** The Senior Pharmacy Claims Professional adjudicates pharmacy claims and ... process pharmacy claims for payment. The Senior Pharmacy Claims Professional work assignments involve moderately complex to complex issues where… more
- Elevance Health (Hanover, MD)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . **How will you make an impact:** + Claim… more
- Humana (Annapolis, MD)
- …informaticists to define various clinical concepts and extract clinical information from medical, pharmacy , and lab claims for analytics and modeling purposes + ... + Healthcare or managed care working experience + Experience working with medical, pharmacy , lab claims + Experience working with big data and using… more
- CareFirst (Baltimore, MD)
- …risk score methodology, risk score calculation, ACA enrollment, premiums, medical and pharmacy claims , and provider data. Incumbent is responsible for performing ... **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Analyst assumes a pro-active approach...as required. **Note:** We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is… more
- Elevance Health (Hanover, MD)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for identifying and ... healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding,… more
- CenterWell (Silver Spring, MD)
- …team at the branch to ensure other billing requirements are satisfied to release claims timely. + Adhere to and participate in Agency's mandatory HIPAA / Privacy ... Guidelines. + Managing all incoming telephone calls in a professional manner including: + Screen and route calls to...at the center. As the nation's largest provider of senior -focused primary care, one of the largest providers of… more